Cancer patients often have comorbid medical problems in addition to their underlying malignant disorders. In fact, patients older than 65 years bear a disproportionate burden of cancer as well as increased prevalence of medical problems such as chronic obstructive pulmonary disease, heart disease, diabetes, and hypertension.[1] Whether patients are seen in primary care or cancer care settings, unexplained symptoms often frustrate physicians and patients.[2] Because many advanced cancers spread to the thorax, symptoms such as dyspnea, cough, chest pain, or palpitations often present a challenge in sorting out the likely cause of the problem and developing appropriate interventions. Cancer patients are often also at higher risk for pulmonary infections.

Clinicians caring for cancer patients should be familiar with the assessment and treatment of common conditions that manifest as chest symptoms. In addition, it is important that these clinicians be familiar with some cancer-specific aspects of chest symptoms and syndromes. Four important cardiopulmonary syndromes commonly caused by malignancy are therefore addressed:

1. Cancer-related dyspnea, including differential diagnostic considerations and treatment of dyspnea as a bothersome symptom.



2. Malignant pleural effusion, including assessment and treatment options.



3. Malignant pericardial effusion, including assessment and treatment options.



4. Superior vena cava syndrome, including assessment and treatment options.

References

1. Yancik R, Ganz PA, Varricchio CG, et al.: Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base. J Clin Oncol 19 (4): 1147-51, 2001.  [PUBMED Abstract]
   
   
2. Komaroff AL: Symptoms: in the head or in the brain? Ann Intern Med 134 (9 Pt 1): 783-5, 2001.  [PUBMED Abstract]
   
   

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